Diuretics
PREGNANCY CATEGORY B OR C
Therapeutic Actions
Diuretics are divided into several subgroups. Thiazide and thiazide-related diuretics inhibit reabsorption of sodium and chloride in the distal renal tubule, increasing the excretion of sodium, chloride, and water by the kidneys. Loop diuretics inhibit the reabsorption of sodium and chloride in the loop of Henle and in the distal renal tubule; because of this added effect, loop diuretics are more potent. Potassium-sparing diuretics block the effect of aldosterone on the renal tubule, leading to a loss of sodium and water and the retention of potassium; their overall effect is much weaker. Osmotic diuretics pull fluid out of the tissues with a hypertonic effect. Overall effect of diuretics is a loss of water and electrolytes from the body.
Indications
Adjunctive therapy in edema associated with heart failure, cirrhosis, corticosteroid and estrogen therapy, renal impairment
Treatment of hypertension, alone or in combination with other antihypertensives
Reduction of intracranial pressure before and during neurosurgery
Reduction of intraocular pressure in acute episodes of glaucoma when other therapies are not successful
Unlabeled uses: Treatment of diabetes insipidus, especially nephrogenic diabetes insipidus, reduction of incidence of osteoporosis in postmenopausal women
Contraindications and Cautions
Contraindicated with fluid or electrolyte imbalances, renal or hepatic disease, gout, SLE, glucose tolerance abnormalities, hyperparathyroidism, manic-depressive disorders, or lactation.
Adverse Effects
CNS: Dizziness, vertigo, paresthesias, weakness, headache, drowsiness, fatigue
CV: Orthostatic hypotension, venous thrombosis, volume depletion, cardiac arrhythmias, chest pain
Dermatologic: Photosensitivity, rash, purpura, exfoliative dermatitis
GI: Nausea, anorexia, vomiting, dry mouth, diarrhea, constipation, jaundice, hepatitis, pancreatitis
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